Project Details


This project will address, at scale, improvement of safe use practices for antipsychotic (AP) treatment ofMedicaid children. Safe and judicious management of APs poses significant challenges, given hazards thatinclude elevated risk of Type 2 diabetes, weight gain, hyperglycemia, hyperlipidemia, and potential long-termimpact on brain development. Safety evidence and guidelines highlight the importance of several key safe-usepractices that can help mitigate these risks, including monitoring blood glucose and lipids; avoiding concurrentuse of multiple different APs; first-line use of non-pharmacological mental health services; and minimizing useamong pre-school children. Prior AHRQ-supported projects have led to HEDIS/CMS quality metrics for thesepractices, but their implementation is highly inconsistent. Many state initiatives have been implemented toimprove these safe-use practices, but the impact of alternative strategies for increasing safe-use is unknown.Evidence on their effects is critically needed. We will use a mixed-methods strategy to identify and documentstate implementation of safe-use initiatives; assess their impact on safe use metrics; investigate causalmechanisms underlying effectiveness; and actively disseminate results to state decisionmakers, health plans,clinical communities, and other stakeholders. This process will support translation, implementation, andimprovement of effective strategies across states. We will provide a comprehensive analysis of systems-levelstrategies, using a national survey and case studies in 8 purposively sampled states, to investigate distinctiveapproaches. We will use key informant interviews and systematic document review to identify implementationtimelines, strategies, causal mechanisms, barriers and solutions, and tools utilized. We will then use Medicaidclaims data to assess change in the use of the targeted practices following the implementation of statesystems-level strategies, using difference-in-difference, triple-difference and other modeling strategies. Statesthat did not implement similar initiatives will serve as comparators. Finally, we will actively disseminate anevidence-informed toolkit to state and stakeholder communities, utilizing active dissemination strategiessuccessfully employed in prior AHRQ-supported partnerships. This toolkit will be developed to facilitate a self-assessment and prioritization of improvement initiatives, identification of other state strategies, and providequality improvement and evaluation tools to assess effectiveness over time. Evidence development and activedissemination will assure that evidence on effective system-improvement processes is available, understood,and effectively used to improve patient safety across populations of vulnerable children served by stateMedicaid/CHIP systems and reduce AP-related harms.
Effective start/end date9/30/187/31/23


  • Agency for Healthcare Research and Quality (AHRQ)


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